The University of West Alabama Policy & Procedure Manual For Athletic Trainers

For home game set-up, each dugout will be provided with:

The following items will be on site at all times:

For away games the following should be taken with you

All Head Coaches, Assistant Coaches, and Graduate Assistant Coaches will be required to annually meet with their athletic trainer on their field, court, or facility to discuss the Emergency Action Plan associated with their program.

All Head Coaches, Assistant Coaches, and Graduate Assistant Coaches will be required to biannually attend a “CPR and AED for Adult” and “First Aid” review course hosted at the university.

Cross-Country

This sport will have only one athletic training student assigned principle provision of athletic training services. They will be responsible for entering all insurance and emergency information for each of their athletes in the computer and keep a copy in their kit at all times. The athletic training student will attend all practices and events with the team. The athletic training student will also work with football during times when cross-country is not practicing or competing.

At practices and home events the student will provide

Be prepared to assist with visiting athletes (they probably will not have an athletic trainer on site).

At away events (it is the coach’s discretion as to whether you will travel) you will take:

At home events, other athletic training students will be assigned to set up first aid stations throughout the course.

All Head Coaches, Assistant Coaches, and Graduate Assistant Coaches will be required to annually meet with their athletic trainer on their field, court, or facility to discuss the Emergency Action Plan associated with their program.

All Head Coaches, Assistant Coaches, and Graduate Assistant Coaches will be required to biannually attend a “CPR and AED for Adult” and “First Aid” review course hosted at the university.

Tennis

This sport will have one to two athletic training students assigned principle provision of athletic training services. They will be responsible for entering all insurance and emergency information for each of their athletes in the computer and keep a copy in their kit at all times. The athletic training student will attend all practices and events with the team. The athletic training student will also work with football during times when cross-country is not practicing or competing.

At practices and home events the student will provide

Be prepared to assist with visiting athletes (they probably will not have an athletic trainer on site).

At away events (it is the coach’s discretion as to whether you will travel) you will take:

The following items will be on for home matches:

All Head Coaches, Assistant Coaches, and Graduate Assistant Coaches will be required to annually meet with their athletic trainer on their field, court, or facility to discuss the Emergency Action Plan associated with their program.

All Head Coaches, Assistant Coaches, and Graduate Assistant Coaches will be required to biannually attend a “CPR and AED for Adult” and “First Aid” review course hosted at the university.

Cheerleading

This sport will have two athletic training students assigned for principle provision of athletic training services. They will be responsible for entering all insurance and emergency information for each of their athletes in the computer and keep a copy in their kit at all times. The athletic training students will attend all practices and events with the team. The athletic training students will also be assigned football responsibilities. At practices the athletic training students will provide only 1 supply kit with emergency information & insurance information.

Men’s & Women’s Soccer

At practice, the staff will be responsible for pre-practice field set-up on a weekly basis, which includes the following:

After practice all equipment and supplies are to be returned. They are also to be washed or restocked and returned to the proper storage area.

At home games the field set-up group will be responsible for providing the following items to our sidelines:

The opposing sidelines will be provided the following: 1 examination table, 1 red water table, 4 water coolers, and 2 - 50 gallon barrels of ice. (Note any item requested within reason will be provided to the opposing team.) All supplies and equipment is to be cleaned and returned to its proper place after the game.

All Head Coaches, Assistant Coaches, and Graduate Assistant Coaches will be required to annually meet with their athletic trainer on their field, court, or facility to discuss the Emergency Action Plan associated with their program.

All Head Coaches, Assistant Coaches, and Graduate Assistant Coaches will be required to biannually attend a “CPR and AED for Adult” and “First Aid” review course hosted at the university.

Intramurals

Athletic training students with appropriate supervision may provide athletic training services for intramural activities throughout the year. Intramurals should have a stocked supply kit at all events. We will not be responsible for providing the supplies necessary for taping or wrapping any student to participate in intramural activity.
NATA CODE OF ETHICS

Preamble

The National Athletic Trainers’ Association Code of Ethics states the principles of ethical behavior that should be followed in the practice of athletic training. It is intended to establish and maintain high standards and professionalism for the athletic training profession. The principles do not cover every situation encountered by the practicing athletic trainer, but are representative of the spirit with which athletic trainers should make decisions. The principles are written generally; the circumstances of a situation will determine the interpretation and application of a given principle and of the Code as a whole. When a conflict exists between the Code and the law, the law prevails. 

1. Members Shall Practice with Compassion, Respecting the Rights, Welfare, and Dignity of Others

1.1 Members shall render quality patient care regardless of the patient’s race, religion, age, sex, ethnic or national origin, disability, health status, socioeconomic status, sexual orientation, or gender identity.

1.2. Member’s duty to the patient is the first concern, and therefore members are obligated to place the welfare and long-term well-being of their patient above other groups and their own self-interest, to provide competent care in all decisions, and advocate for the best medical interest and safety of their patient at all times as delineated by professional statements and best practices.

1.3. Members shall preserve the confidentiality of privileged information and shall not release or otherwise publish in any form, including social media, such information to a third party not involved in the patient’s care without a release unless required by law.

 

2. Members Shall Comply With the Laws and Regulations Governing the Practice of Athletic Training, National Athletic Trainers’ Association (NATA) Membership Standards, and the NATA Code of Ethics

2.1. Members shall comply with applicable local, state, federal laws, and any state athletic training practice acts.

2.2. Members shall understand and uphold all NATA Standards and the Code of Ethics.

2.3. Members shall refrain from, and report illegal or unethical practices related to athletic training.

2.4. Members shall cooperate in ethics investigations by the NATA, state professional licensing/regulatory boards, or other professional agencies governing the athletic training profession. Failure to fully cooperate in an ethics investigation is an ethical violation.

2.5. Members must not file, or encourage others to file, a frivolous ethics complaint with any organization or entity governing the athletic training profession such that the complaint is unfounded or willfully ignore facts that would disprove the allegation(s) in the complaint.

2.6. Members shall refrain from substance and alcohol abuse.  For any member involved in an ethics proceeding with NATA and who, as part of that proceeding is seeking rehabilitation for substance or alcohol dependency, documentation of the completion of rehabilitation must be provided to the NATA Committee on Professional Ethics as a requisite to complete a NATA membership reinstatement or suspension process.  

 

3. Members Shall Maintain and Promote High Standards in Their Provision of Services

3.1. Members shall not misrepresent, either directly or indirectly, their skills, training, professional credentials, identity, or services.

3.2. Members shall provide only those services for which they are qualified through education or experience and which are allowed by the applicable state athletic training practice acts and other applicable regulations for athletic trainers.

3.3. Members shall provide services, make referrals, and seek compensation only for those services that are necessary and are in the best interest of the patient as delineated by professional statements and best practices.

3.4. Members shall recognize the need for continuing education and participate in educational activities that enhance their skills and knowledge and shall complete such educational requirements necessary to continue to qualify as athletic trainers under the applicable state athletic training practice acts.

3.5. Members shall educate those whom they supervise in the practice of athletic training about the Code of Ethics and stress the importance of adherence.

3.6. Members who are researchers or educators must maintain and promote ethical conduct in research and educational activities.

 

4. Members Shall Not Engage in Conduct That Could Be Construed as a Conflict of Interest, Reflects Negatively on the Athletic Training Profession, or Jeopardizes a Patient’s Health and Well-Being.

4.1. Members should conduct themselves personally and professionally in a manner that does not compromise their professional responsibilities or the practice of athletic training.

4.2. All NATA members, whether current or past, shall not use the NATA logo in the endorsement of products or services, or exploit their affiliation with the NATA in a manner that reflects badly upon the profession.

4.3. Members shall not place financial gain above the patient’s welfare and shall not participate in any arrangement that exploits the patient.

4.4. Members shall not, through direct or indirect means, use information obtained in the course of the practice of athletic training to try and influence the score or outcome of an athletic event, or attempt to induce financial gain through gambling.

4.5. Members shall not provide or publish false or misleading information, photography, or any other communications in any media format, including on any social media platform, related to athletic training that negatively reflects the profession, other members of the NATA, NATA officers, and the NATA office.

_{September 2005, Revised 2016}

WORKPLACE DISCRIMINATION AND HARASSMENT (NATA Brochure)
Equal opportunity in the workplace means that the workplace is free of both discrimination and harassment. Workplace discrimination occurs when an employment decision is made on the basis of race, color, gender, creed, religion, national origin, age, gender (including pregnancy), disability, veteran/military status or any other status protected by law. Workplace harassment occurs when there is unwelcome conduct based on the protected categories noted above; the harassment may create a hostile work environment (which means that a reasonable person finds the environment hostile) or may a quid pro quo situation (where a benefit or detriment is conditioned on submission to the offensive conduct). Equal opportunity also means that the workplace is free from retaliation for reporting or participating in investigations of discrimination and harassment.
Additional information about this subject is available at the website maintained by the Equal Employment Opportunity Commission that can be found at eeoc.gov.
NATA encourages its members to create and maintain workplaces free of discrimination and harassment and to report any unlawful behavior to the appropriate parties at their workplace.
HEALTH & SAFETY POLICY OF THE UWA ATHLETIC TRAINING PROGRAM
Safeguards are taken for the health and safety of patients, students, graduate assistants, and faculty/staff. These are:

1. 
   Each athletic training student is required to have received a Hepatitis B Vaccine or signed a wavier prior to entry into the program.
   
2. 
   Modalities are checked and serviced annually for potential problems.
   
3. 
   No student is allowed to use a modality without specific instructions from a clinical instructor and the student having shown competence with the modality.
   
4. 
   Students are required to be Standard First Aid & Professional Rescuer certified before admission into the program and must gain re-certification each year. Each student will also be AED certified.
   
5. 
   First year students must successfully pass two practicums in athletic training classes and attend the preseason in-service program prior to performing athletic training activities in the athletic training facility.
   
6. 
   OSHA guidelines are followed very closely. All students stating they have read the guidelines and universal precautions and understand and will adhere to them must sign a consent form. Also, a training session on the OSHA guidelines and universal precautions is required each year of all athletic training students.
   
7. 
   The local health department is retained to dispose of medical waste and sharp objects.
   
8. 
   Appropriate emergency procedures are discussed and demonstrated with each new athletic training student.
   
9. 
   Each athletic training student must take part in a yearly in-service on the appropriate techniques of emergency procedures.
   
10. 
    All emergency action plans and potentially important phone numbers are posted at specific locations should an emergency situation arise.
    

Bloodborne Pathogens Exposure Control Plan

In accordance with the Occupational Safety Health Administration (OSHA) Bloodborne Pathogens Standard, 29 CFR 1910.1030, the following Exposure Control Plan has been developed:

1. Exposure Determination

OSHA requires employers to perform an exposure determination concerning which employees may incur occupational exposure to blood or other potentially infectious materials. The exposure determination is made without regard to the use of personal protective equipment (i.e., employees are considered to be exposed even if they wear personal protective equipment). This exposure determination affects all full-time athletic trainers on staff, graduate assistants, and athletic training students at The University of West Alabama working directly with University athletes or athletes participating on the University campus as part of a program sponsored by or hosted by The University of West Alabama.

The job classifications and associated tasks for these categories are as follows:

1. 
   Athletic Training Staff members will be expected to provide emergency treatment for life-threatening emergencies, including administering mouth-to-mouth resuscitation and controlling bleeding occurring due to participation in athletics. Also, the staff member may be involved in assisting team physicians with suturing, draining blisters, applying band-aids, or shaving calluses.
   
2. 
   Graduate Assistants and Athletic training students will often be required to perform the same tasks when the situation requires.
   

2. Implementation Schedule and Methodology

OSHA also requires that this plan include a schedule and method of implementation for the various requirements of the standard. The following complies with this requirement:

1. 
   Compliance Methods
   

Universal Precautions will be observed at this facility in order to prevent contact with blood, blood products, or other potentially infectious materials. All blood, blood product, or other potentially infectious material will be considered infectious regardless of the perceived status of the source or source individual.

Engineering and work practice controls will be used to eliminate or minimize exposure to employees at this facility. Where occupational exposure remains after institution of these controls, personal protective equipment shall be used (refer to the Policies & Procedures Manual: All staff, graduate assistants, and athletic training students will use personal protective equipment in dealing with any potentially infectious material). At this facility, sharps containers, waste disposable bags, and clearly marked biohazardous waste containers will be used as engineering controls.

The above controls will be examined and maintained on a regular basis, with attention given to the contents of the engineering controls to insure removal once the containers reach 1/2 to 3/4 of capacity. The effectiveness of the controls shall be reviewed on a semiannual basis by an individual appointed by the Head or Assistant Athletic Trainers.

Hand washing facilities are also available to the employees who incur exposure to blood or other potentially infectious materials. OSHA requires that these facilities be readily accessible after incurring exposure. At this facility, there are two hand-washing facilities located in the athletic training facility, in each athletic locker facility, in each coach’s locker room, and in each of the public restrooms. There are no available facilities at game/practice sites. As an alternative, a 10% bleach and water solution and isopropyl alcohol are stored in each athletic trainer's kit on the site. If this alternate method is used, the hands are to be washed with soap and running water as soon as feasible following any exposure.

After proper removal and disposal of personal protective gloves or other personal protective equipment, employees shall wash their hands and any other potential contaminated skin area immediately or soon as feasible with soap and water.

If employees incur exposure to their skin or mucous membranes, then those areas shall be washed or flushed with water as appropriated or as soon as feasible following contact.

2. 
   Needles
   

Contaminated needles and other contaminated sharps objects will not be bent, recapped, removed, sheared, or purposely broken. Following usage needles or other contaminated sharps objects will be disposed of in a clearly marked biohazardous, sharps container. OSHA allows for one exception to the rule governing the disposal of needles, if the procedure requires that the contaminated needles be recapped or removed and no alternative is feasible, and the action is required by the medical procedure. If such action is required, then the recapping or removal of the needle must be done by the use of a mechanical device or a one handed technique. At this facility recapping or removal is only permitted while assisting one of the team physicians in a procedure necessitating this act.

3. 
   Containers for Reusable Sharps
   

Contaminated sharps that are not reusable are to be placed immediately, or as soon as possible after use, into appropriated sharps containers. At this facility, the sharps containers are puncture resistant, labeled with a biohazard label, and are leak proof. The sharps container is located in the cabinet above the first aid area of the main athletic training island. An individual appointed by the Head Athletic Trainer has the responsibility for disposal of the sharps container when it becomes ¾ full. The container need only be checked as necessitated by its use.

4. 
   Work Area Restrictions
   

In work areas where there is a reasonable likelihood of exposure to blood or other potentially infectious materials, employees are not to eat, drink, apply cosmetics or lip balm, smoke, or handle contact lenses. Food and beverages are not to be kept or placed on treatment tables, taping decks, or countertops when blood or other potentially infectious materials are likely to be present.

Mouth pipetting or suctioning of blood or other potentially infectious materials is prohibited.

All procedures will be conducted in a manner that will minimize splashing, spraying, splattering, and generation of droplets of blood or other potentially infectious materials.

5. 
   Specimens
   

Specimens of blood or other potentially infectious materials, such as urine, will be placed in a container that prevents leakage during the collection, handling, processing, storage, and transport of the specimens.

The container used for this purpose will be labeled or color-coded in accordance with the requirements of the OSHA standards. It should be noted that this standard provides for an exemption for specimens from the labeling/color coding requirements of the standard, provided the facility uses Universal Precautions in the handling of all specimens and the containers are recognizable as container specimens. This exemption applies only while the specimens remain in the facility.

If outside contamination of the primary container occurs, the primary container shall be placed within a secondary container that prevents leakage during the handling, processing, storage, transport, and/or shipping of the specimen.

6. 
   Contaminated Equipment
   

Equipment that has become contaminated with blood or other potentially infectious materials shall be examined before servicing or shipping and shall be decontaminated as necessary unless the decontamination of the equipment is not feasible.

7. 
   Personal Protective Equipment
   

All personal protective equipment used at the facility will be provided without cost to employees. Personal protective equipment will be chosen based on the anticipated exposure to blood or other potentially infectious materials. The protective equipment will be considered appropriate only if it does not permit blood or other potentially infectious materials to pass through or reach employees' clothing, skin, eyes, mouth, or other mucous membranes under normal conditions of use and for the duration of time that the protective equipment will be used. The protective equipment necessary for the athletic training facility primarily consists of latex gloves. These gloves will be stored on the main athletic training facility island, in the first aid cabinet of the taping room, and in all athletic training kits used by the staff, graduate assistants and students, and in all individual fanny packs. These gloves will be available at all times and at no cost to the staff, graduate assistants, or students.

There is also other protective equipment made available to everyone at no cost to the staff, graduate assistants, and students. They are listed below.

Personal Protective Equipment

All personal protective equipment will be cleaned, laundered, and disposed of by the employer at no cost to the employees. The employer at no cost to employees will make all repairs and replacements.

All garments that are penetrated by blood shall be removed immediately or as soon as feasible. All personal protective equipment will be removed before leaving the work area.

Gloves shall be worn where it is reasonably anticipated that employees will have hand contact with blood, other potentially infectious materials, non-intact skin, and mucous membranes. Gloves will be used for the following procedures:

Disposable gloves used at the facility are not to be washed or decontaminated for reuse. They are to be replaced as soon as practical when they become contaminated or as soon as feasible when or if they are torn, punctured, or when their ability to function as a barrier is compromised. Utility gloves may be decontaminated for reuse provided that the integrity of the glove is not compromised. Utility gloves will be discarded if they are cracked, peeling, torn, punctured, or exhibit other signs of deterioration or when their ability to function as a barrier is compromised.

The facility will be cleaned and decontaminated daily when the athletic training facility is used by athletes. Decontamination will also take place after any blood or other potentially infectious material has been exposed in the athletic training facility. Decontamination will be accomplished by using a 10% bleach and water solution available in the cabinet under each sink counter and in all athletic trainers' kits.

Any broken glassware that may be contaminated will not be picked up directly with the hands. Cardboard sheets should be used to corner and lift any broken pieces. All broken glass or material should be placed in a sharps container for disposal.

8. 
   Regulated Waste Disposal
   

All contaminated sharps shall be discarded as soon as feasible in sharps containers located in the facility. Sharps containers are located in the areas listed above.

Regulated waste other than sharps shall be placed in appropriate containers with color-coded waste bags. Such containers are located in the Homer Athletic Training Facility, Pruitt Athletic Training Facility, taping room, baseball field and softball field.

These containers are supervised by the designated person(s), and are disposed of by the Sumter County Health Department.

9. 
   Laundry Procedures
   

Laundry contaminated with blood or other potentially infectious materials will be handled as little as possible. Such laundry will be placed in appropriately marked bags where it is used. This laundry will not be sorted or rinsed in the area of use. It will then be removed by the individual responsible for laundry using personal protective equipment, and washed separately in bleach.

All employees who handle contaminated laundry will use personal protective equipment to prevent contact with blood or other potentially infectious materials.

10. 
    HIV/HBV Exposure
    

Post Exposure Evaluation and Follow-Up

When an employee incurs an exposure incident, it should be reported to the Head or Assistant Athletic Trainer. All employees who incur an exposure will be offered post" exposure evaluation and follow-up in accordance with the OSHA standard. This follow-up will include the following:

1. 
   Written documentation of the route of exposure and the circumstances related to the incident as soon as feasible following the exposure. This is to be returned to the Head or Assistant Athletic Trainer
   
2. 
   If possible, the identification of the source individual and, if possible, the status of the source individual. The blood of the source individual will be tested after consent is obtained for HIV/HBV infection.
   
3. 
   Results of testing of the source individual will be made available to the exposed employee with the exposed employee informed about the applicable laws and regulations concerning disclosure of the identity and infection of the source individual.
   
4. 
   The employee will be offered the option of having their blood collected for testing of the employee's HIV/HBV serological status. The blood sample will be preserved for up to 90 days to allow the employee to decide if the blood should be tested for HIV serological status. However, if the employee decides before that time that testing will or will not be conducted then the appropriate action can be taken and the blood sample discarded.
   
5. 
   The employee will be offered post-exposure prophylaxis in accordance with the current recommendations of the U.S. Public Health Service.
   
6. 
   The employee will be referred to appropriate counseling centers concerning precautions to take during the period after the exposure incident. The employee will also be given information on what potential illness to be alert for and to report any related experiences to appropriate personnel.
   
7. 
   The Head Athletic Trainer will be designated to assure that the policy outlined above is effectively carried out as well as to maintain records related to this policy.
   

11. 
    Interaction with Health Care Professionals
    

A written opinion shall be obtained from the health care professional that evaluates employees of this facility. Written opinions will be obtained in the following instances:

1. 
   When the employee is sent to obtain the Hepatitis B vaccine.
   
2. 
   Whenever the employee is sent to a health care professional following an exposure incident.
   

Health care professionals shall be instructed to limit their opinions to:

1. 
   Whether the Hepatitis B vaccine is indicated and if the employee has received the vaccine, or for evaluation following an incident.
   
2. 
   That the employee has been informed of the results of the evaluation.
   
3. 
   That the employee has been told about any medical conditions resulting from exposure to blood or other potentially infectious materials. (Note: The written opinion to the employer is not to reference any personal medical information).
   

12. 
    Training
    

Training for all employees will be conducted before initial assignment to tasks where occupational exposure may occur. Training for employees will include an explanation of the following:

1. 
   The OSHA Standard for Bloodborne Pathogens
   
2. 
   Epidemiology and symptomatology of bloodborne disease
   
3. 
   Modes of transmission of bloodborne pathogens
   
4. 
   The exposure plan (i.e., points of the plan, lines of responsibility, how the plan will be implemented, etc.)
   
5. 
   Procedures that might cause exposure to blood or other potentially infectious material at this facility.
   
6. 
   Control methods to be used at the facility to control exposure to blood or other potentially infectious materials.
   
7. 
   Personal protective equipment available at this facility
   
8. 
   Who should be contacted concerning exposure to blood or other potentially infectious materials.
   
9. 
   Post-exposure evaluation and follow-up.
   
10. 
    Signs and labels used at the faculty.
    
11. 
    Hepatitis B vaccine program at the facility.
    

13. 
    Record Keeping
    

All records required by the OSHA standard will be maintained by an employee appointed by the Head Athletic Trainer. All provisions required by the standard will be implemented by August 1, 2008. The athletic training staff will be responsible for conducting the training to the graduate assistants and athletic training students during preseason orientation. All employees will receive annual refresher training within one year of the employee's previous training. The OSHA Standard for Bloodborne Pathogens and the outline for the training material will be kept in the office of the Head Athletic Trainer and in the policies manual at the Athletic Training Facility Desk by the main entrance.

14. 
    Athletics Health Care Responsibilities
    

The following information was taken from the 2012-2013 NCAA Sports Medicine Handbook, Twenty-third edition, August 2012, page 68-72.

Blood-borne pathogens are disease causing microorganisms that can be potentially transmitted through blood contact. The blood-borne pathogens of concern include (but are not limited to) the hepatitis B virus (HBV) and the human immunodeficiency virus (HIV). Infections with these (HBV, HIV) viruses have increased throughout the last decade among all portions of the general population. These diseases have potential for catastrophic health consequences. Knowledge and awareness of appropriate preventive strategies are essential for all members of society, including student-athletes. The particular blood-borne pathogens HBV and HIV are transmitted through sexual contact (heterosexual and homosexual), direct contact with infected blood or blood components, and perinatally from mother to baby. In addition, behaviors such as body piercing and tattoos may place student-athletes at some increased risk for contracting HBV, HIV or Hepatitis C. The emphasis for the student athlete and the athletics health-care team should be placed predominately on education and concern about these traditional routes of transmission from behaviors off the athletics field. Experts have concurred that the risk of transmission on the athletics field is minimal.

Hepatitis B Virus (HBV)

HBV is a blood-borne pathogen that can cause infection of the liver. Many of those infected will have no symptoms or a mild flu-like illness. One-third will have severe hepatitis, which will cause the death of one percent of that group. Approximately 300,000 cases of acute HBV infection occur in the United States every year, mostly in adults.

Five to 10 percent of acutely infected adults become chronically infected with the virus (HBV carriers). Currently in the United States there are approximately one million chronic carriers. Chronic complications of HBV infection include cirrhosis of the liver and liver cancer.

Individuals at the greatest risk for becoming infected include those practicing risky behaviors of having unprotected sexual intercourse or sharing intravenous (IV) needles in any form. There is also evidence that household contacts with chronic HBV carriers can lead to infection without having had sexual intercourse or sharing of IV needles. These rare instances probably occur when the virus is transmitted through unrecognized-wound or mucous-membrane exposure. The incidence of HBV in student athletes is presumably low, but those participating in risky behavior off the athletics field have an increased likelihood of infection (just as in the case of HIV). An effective vaccine to prevent HBV is available and recommended for all college students by the American College Health Association. Numerous other groups have recognized the potential benefits of universal vaccination of the entire adolescent and young-adult population.

HIV (AIDS Virus)

The Acquired Immunodeficiency Syndrome (AIDS) is caused by the human immunodeficiency virus (HIV), which infects cells of the immune system and other tissues, such as the brain. Some of those infected with HIV will remain asymptomatic for many years. Others will more rapidly develop manifestations of HIV disease (i.e., AIDS). Some experts believe virtually all persons infected with HIV eventually will develop AIDS and that AIDS is uniformly fatal. In the United States, adolescents are at special risk for HIV infection. This age group is one of the fastest growing groups of new HIV infections. Approximately, 14 percent of all new HIV infections occur in persons aged between 12-24 years. The risk of infection is increased by having unprotected sexual intercourse, as well as the sharing of IV needles in any form. Like HBV, there is evidence that suggests that HIV has been transmitted in household-contact settings without sexual contact or IV needle sharing among those household contacts5,6. Similar to HBV, these rare instances probably occurred through unrecognized wound or mucous membrane exposure.

Comparison of HBV/HIV

Hepatitis B is a much more “sturdy/durable” virus than HIV and is much more concentrated in blood. HBV has a much more likely transmission with exposure to infected blood; particularly parenteral (needle-stick) exposure, but also exposure to open wounds and mucous membranes. There has been one well-documented case of transmission of HBV in the athletics setting, among sumo wrestlers in Japan. There are no validated cases of HIV transmission in the athletics setting. The risk of transmission for either HBV or HIV on the field is considered minimal; however, most experts agree that the specific epidemiologic and biologic characteristics of the HBV virus make it a realistic concern for transmission in sports with sustained close physical contact, such as wrestling. HBV is considered to have a potentially higher risk of transmission than HIV.

Testing of Student-Athletes

Routine mandatory testing of student-athletes for either HBV or HIV for participation purposes is not recommended. Individuals who desire voluntary testing based on personal reasons and risk factors, however, should be assisted in obtaining such services by appropriate campus or public-health officials.

Student-athletes who engage in high-risk behavior are encouraged to seek counseling and testing. Knowledge of one’s HBV and HIV infection is helpful for a variety of reasons, including the availability of potentially effective therapy for asymptomatic patients, as well as modification of behavior, which can prevent transmission of the virus to others. Appropriate counseling regarding exercise and sports participation also can be accomplished.

Participation by the Student-Athlete with Hepatitis B (HBV) Infection

Individual’s Health––In general, acute HBV should be viewed just as other viral infections. Decisions regarding ability to play are made according to clinical signs and symptoms, such as fatigue or fever. There is no evidence that intense, highly competitive training is a problem for the asymptomatic HBV carrier (acute or chronic) without evidence of organ impairment. Therefore, the simple presence of HBV infection does not mandate removal from play.

Disease Transmission—The student-athlete with either acute or chronic HBV infection presents very limited risk of disease transmission in most sports. However, the HBV carrier presents a more distinct transmission risk than the HIV carrier (see previous discussion of comparison of HBV to HIV) in sports with higher potential for blood exposure and sustained close body contact. Within the NCAA, wrestling is the sport that best fits this description.

The specific epidemiologic and biologic characteristics of hepatitis B virus form the basis for the following recommendation: If a student-athlete develops acute HBV illness, it is prudent to consider removal of the individual from combative, sustained close-contact sports (e.g., wrestling) until loss of infectivity is known. (The best marker for infectivity is the HBV antigen, which may persist up to 20 weeks in the acute stage). Student-athletes in such sports who develop chronic HBV infections (especially those who are e-antigen positive) should probably be removed from competition indefinitely, due to the small but realistic risk of transmitting HBV to other student-athletes.

Participation of the Student-Athlete with HIV

Individual’s Health—In general, the decision to allow an HIV positive student-athlete to participate in intercollegiate athletics should be made on the basis of the individual’s health status. If the student-athlete is asymptomatic and without evidence of deficiencies in immunologic function, then the presence of HIV infection in and of itself does not mandate removal from play.

The team physician must be knowledgeable in the issues surrounding the management of HIV infected student-athletes. HIV must be recognized as a potentially chronic disease, frequently affording the affected individual many years of excellent health and productive life during its natural history. During this period of preserved health, the team physician may be involved in a series of complex issues surrounding the advisability of continued exercise and athletics competition.

The decision to advise continued athletics competition should involve the student-athlete, the student-athlete’s personal physician and the team physician. Variables to be considered in reaching the decision include the student-athlete’s current state of health and the status of his/her HIV infection, the nature and intensity of his/her training, and potential contribution of stress from athletics competition to deterioration of his/her health status.

There is no evidence that exercise and training of moderate intensity is harmful to the health of HIV infected individuals. What little data that exists on the effects of intense training on the HIV-infected individual demonstrates no evidence of health risk. However, there is no data looking at the effects of long-term intense training and competition at an elite, highly competitive level on the health of the HIV-infected student-athlete.

Disease Transmission—Concerns of transmission in athletics revolve around exposure to contaminated blood through open wounds or mucous membranes. Precise risk of such transmission is impossible to calculate but epidemiologic and biologic evidence suggests that it is extremely low (see section on comparison of HBV/HIV). There have been no validated reports of transmission of HIV in the athletics setting3,13 Therefore, there is no recommended restriction of student-athletes merely because they are infected with HIV, although one court has upheld the exclusion of an HIV-positive athlete from the contact sport of karate.19

Administrative Issues

The identity of individuals infected with a blood-borne pathogen must remain confidential. Only those persons in whom the infected student-athlete chooses to confide have a right to know about this aspect of the student-athletes medical history. This confidentiality must be respected in every case and at all times by all college officials, including coaches, unless the student-athlete chooses to make the fact public.

Athletics Health-Care Responsibilities

The following recommendations are designed to further minimize risk of blood-borne pathogens and other potentially infectious organisms transmission in the context of athletics events and to provide treatment guidelines for caregivers.

In the past, these guidelines were referred to as “Universal (blood and body fluid) Precautions.” Over time, the recognition of “Body Substance Isolation,” or that infectious diseases may also be transmitted from moist body substances, has led to a blending of terms now referred to as “Standard Precautions.” Standard precautions, applies to blood, body fluids, secretions and excretions except sweat, regardless of whether or not they contain visible blood. These guidelines, originally developed for health-care, have additions or modifications relevant to athletics. They are divided into two sections; the care of the student-athlete, and cleaning and disinfection of environmental surfaces.

Care of the Athlete:

1. 
   All personnel involved in sports who care for injured or bleeding student-athletes should be properly trained in first aid, and standard precautions.
   
2. 
   Assemble and maintain equipment and/or supplies for treating injured/bleeding athletes. Items may include: Personal Protective Equipment (PPE) [minimal protection includes gloves; goggles, mask, fluid resistant gown if chance of splash or splatter]; antiseptics; antimicrobial wipes; bandages or dressings; medical equipment needed for treatment; appropriately labeled “sharps” container for disposal of needles, syringes, scalpels; and waste receptacles appropriate for soiled equipment, uniforms, towels and other waste.
   
3. 
   Pre-event preparation includes proper care for wounds, abrasions, or cuts that may serve as a source of bleeding or as a port of entry for blood-borne pathogens or other potentially infectious organisms. These wounds should be covered with an occlusive dressing that will withstand the demands of competition. Likewise, care providers with healing wounds or dermatitis should have these areas adequately covered to prevent transmission to or from a participant. Student-athletes may be advised to wear more protective equipment on high-risk areas, such as elbows and hands.
   
4. 
   The necessary equipment and/or supplies important for compliance with universal precautions should be available to caregivers. These supplies include appropriate gloves, disinfectant bleach, antiseptics, designated receptacles for soiled equipment and uniforms, bandages and/or dressings and a container for appropriate disposal of needles, syringes or scalpels.
   
5. 
   When a student-athlete is bleeding, the bleeding must be stopped and the open wound covered with a dressing sturdy enough to withstand the demands of activity before the student-athlete may continue participation in practice or competition. Current NCAA policy mandates the immediate, aggressive treatment of open wounds or skin lesions that are deemed potential risks for transmission of disease. Participants with active bleeding should be removed from the event as soon as is practical. Return to play is determined by appropriate medical staff personnel and/or sport officials. Any participant whose uniform is saturated with blood must change their uniform before return to participation.
   
6. 
   During an event, early recognition of uncontrolled bleeding is the responsibility of officials, student-athletes, coaches and medical personnel. In particular, student-athletes should be aware of their responsibility to report a bleeding wound to the proper medical personnel.
   
7. 
   Personnel managing an acute blood exposure must follow the guidelines for universal precaution. Gloves and other PPE if necessary should be worn for direct contact with blood or other body fluids. Gloves should be changed after treating each individual participant. After removing gloves, hands should be washed.
   
8. 
   If blood or body fluids are transferred from an injured or bleeding student-athlete to the intact skin of another athlete, the event must be stopped, the skin cleaned with antimicrobials wipes to remove gross contaminate, and the athlete instructed to wash with soap and water as soon as possible. NOTE: Chemical germicides intended for use on environmental surfaces should never be used on student athletes.
   
9. 
   Any needles, syringes, or scalpels should be carefully disposed of in an appropriately labeled “sharps” container. Medical equipment, bandages, dressings, and other waste should be disposed of according to facility protocol. During events, uniforms or other contaminated linens should be disposed of in a designated container to prevent contamination of other items or personnel. At the end of competition, the linen should be laundered and dried according to facility protocol; hot-water at temperatures of 71°C (160°F) for 25 minutes cycles may be used.
   

Care of Environmental Surfaces:

1. 
   All individuals responsible for cleaning and disinfection of blood spills or other potentially infectious materials (OPIM) should be properly trained on procedures and the use of standard precautions.
   
2. 
   Assemble and maintain supplies for cleaning and disinfection of hard surfaces contaminated by blood or OPIM. Items include: Disposable gloves (PPE) [goggles, mask, fluid resistant gown if chance of splash or splatter]; supply of absorbent paper towels or disposable cloths; red plastic bag with the biohazard symbol on it or other waste receptacle according to facility protocol, properly diluted tuberculocidal disinfectant or freshly prepared bleach solution diluted (1:10 bleach/water ratio).
   
3. 
   Put on disposable gloves.
   
4. 
   Remove visible organic material by covering with paper towels or disposable cloths. Place soiled towels or cloths in red bag or other waste receptacle according to facility protocol. (Use additional towels or cloths to remove as much organic material as possible from the surface and place in the waste receptacle.)
   
5. 
   Spray the surface with a properly diluted chemical germicide used according to manufacturer’s label recommendations for disinfection, and wipe clean. Place soiled towels in waste receptacle.
   
6. 
   Spray the surface with either a properly diluted tuberculocidal chemical germicide or a freshly prepared bleach solution diluted 1:10, and follow manufacturer’s label directions for disinfection; wipe clean. Place towels in waste receptacle.
   
7. 
   Remove gloves and wash hands.
   
8. 
   Dispose of waste according to facility protocol.
   

Final Notes:

1. 
   All personnel responsible for caring for bleeding individuals should be encouraged to obtain a Hepatitis B (HBV) vaccination.
   
2. 
   Latex allergies should be considered. Non-latex gloves may be used for treating student-athletes and the cleaning and disinfection of environmental surfaces.
   
3. 
   Occupational Safety and Health Administration (OSHA) standards for Bloodborne Pathogens (Standard #29 CFR 1910.1030) and Hazard Communication (Standard #29 CFR 1910.1200) should be reviewed for further information. Member institutions should ensure that policies exist for orientation and education of all health-care workers on the prevention and transmission of blood-borne pathogens. Additionally, in 1992, the Occupational Safety and Health Administration (OSHA) developed a standard directed to eliminating or minimizing occupational exposure to blood-borne pathogens. Many of the recommendations included in this guideline are part of the standard. Each member institution should determine the applicability of the OSHA standard to its personnel and facilities.
   

The University of West Alabama

Athletic Training Program

OSHA Compliance Statement
Blood borne pathogens are disease causing microorganisms that may be present in human blood. Two pathogens that are of special importance to athletic trainers are Hepatitis B Virus (HBV) and Human Immunodeficiency Virus (HIV). Hepatitis B directly affects the liver by resulting in swelling, soreness, and the loss of normal functions to the liver. Human Immunodeficiency Virus affects the immune system by destroying the T-cells which helps prevent disease. At this time, there is no known cure for either. At this time there is a vaccine for prevention of HBV that is available.

All individuals working within The University of West Alabama Athletic Training & Sports Medicine Center are anticipated to come in contact with blood or other infectious materials while performing their duties. The potential for exposure not only exists in the athletic training facilities, but also on the practice and/or competition fields.

These potential areas of exposure and disease transmission as well as, techniques of transmission prevention are documented and outlined in the “Health and Safety Policy of The University of West Alabama Athletic Training Program”, I have been given. I have read, understand, and will follow the “Health and Safety Policy of The University of West Alabama Athletic Training Program”. I also understand that I must take part in yearly in-service programs on the OSHA guidelines and universal precautions.

Year 1 Student Signature _______________________________________ Date ______________
Staff Signature / Witness _________________________________ Date ______________

Year 2 Student Signature _______________________________________ Date ______________
Staff Signature / Witness _________________________________ Date ______________

Year 3 Student Signature _______________________________________ Date ______________
Staff Signature / Witness _________________________________ Date ______________

Year 4 Student Signature _______________________________________ Date ______________
Staff Signature / Witness _________________________________ Date ______________

Year 5 Student Signature _______________________________________ Date ______________
Staff Signature / Witness _________________________________ Date ______________
The University of West Alabama

Athletic Training Program

Hepatitis B Vaccine Waiver Form
All athletic trainers, who have been identified as being at risk for exposure to blood or other potentially infectious materials, are offered the Hepatitis B vaccine. The three stage vaccine is offered through The University of West Alabama's team physician, Dr. James Robinson or the Marengo County Health Department (Demopolis, AL) at minimal cost to the athletic training student. Dr. Robinson’s cost is $260 and Marengo County Health Department $5 to administer the vaccine and approximately $60 for the prescription at The Drug Store in Livingston. The Sumter County Health Department will provide the vaccine and injection FREE if you are Nineteen Years of age or younger. The above stated costs are subject to change.
I understand that due to my occupational exposure to blood or other potentially infectious materials, I may be at risk of acquiring the Hepatitis B Virus (HBV). I wish to be vaccinated at this time at one of the above locations. Upon which time I will submit my record of vaccination to the Program Director of the UWA Athletic Training Program.

Student Signature		Date

I have been given the opportunity to be vaccinated. However, I decline the vaccine at this time. I understand that by declining this vaccine, I continue to be at risk of acquiring Hepatitis B, a serious disease. If in the future I continue to have occupational exposure to blood or other potentially infectious materials and I want to be vaccinated with the Hepatitis B vaccine, I can receive the vaccination series at the above expense through one of the above locations.

Student Signature		Date
Student Signature		Date

I have initiated my Hepatitis B vaccination and will be completing it within the next 6 months. Upon which time I will submit my record of vaccination to the Program Director of the UWA Athletic Training Program.

Student Signature		Date
Current Number of Injections Taken

I have already received my complete Hepatitis B vaccination and will submit my record of vaccination to the Program Director of the UWA Athletic Training Program.

Student Signature		Date

COMMUNICABLE DISEASE POLICY

The purpose of the University of West Alabama Athletic Training Program Communicable Disease Policy is to protect the health and safety of all parties. The purpose of this policy is to ensure the welfare of the students enrolled within this program as well as those patients you may come in contact with during your clinical experiences. It is designed to provide Athletic Training Students, Preceptors, and athletic training faculty with a plan to assist in the management of students with infectious diseases as defined by the Centers for Disease Control and Prevention (CDC). This policy was developed using the recommendations established by the CDC for health care workers (www.cdc.gov).

What are Communicable Diseases?

A communicable disease is a disease that can be transmitted from one person to another. There are four main types of transmission including direct physical contact, air (through a cough, sneeze, or other particle inhaled), a vehicle (ingested or injected), and a vector (via animals or insects).

Communicable Diseases Cited by the CDC:

Guidelines for Prevention of Exposure and Infection

1. 
   Students must successfully complete annual Bloodborne pathogens training prior to initiating observational and formal clinical experiences.
   
2. 
   Students are required to use proper hand washing techniques and practice good hygiene at all times.
   
3. 
   Students are required to use Universal Precautions at all times. This applies to all clinical sites.
   
4. 
   Patient care should not be performed when the athletic training student has active signs or symptoms of a communicable disease.
   

Guidelines for Managing Potential Infection

1. 
   Any student who has been exposed to a potential infection before, during, or after a clinical experience should report that exposure to his/her preceptor immediately and subsequently to the Clinical Education Coordinator.
   
2. 
   Any student, who demonstrates signs or symptoms of infection or disease that may place him/her and/or his/her patients at risk, should report that potential infection or disease immediately to his/her supervising clinical instructor.
   
3. 
   The student is responsible for keeping the Clinical Education Coordinator informed of his/her conditions that require extended care and/or missed class/clinical time. The student may be required to provide written documentation from a physician to return to class and/or clinical site.
   
4. 
   If a student feels ill enough to miss ANY class or clinical experience that student should notify the appropriate instructor or preceptor immediately. Any absence must be supported with written documentation from a physician.
   

By signing below, you indicate you understand and will abide by the University of West Alabama Athletic Training Program Communicable Disease Policy. Any breach of the Communicable Disease Policy will result in disciplinary action outlined in the UWA Policy & Procedure Manual for Athletic Trainers and as determined by the Athletic Training Curriculum Selection Committee.

Athletic Training Student Name (Print) Athletic Training Student Signature Date

CONFIDENTIALITY STATEMENT

for

ATHLETIC TRAINING STUDENTS

I,		, understand that information in the
	Please Print Full Name

offices of the Athletic Training Facility and the Athletic Department of The University of West Alabama is confidential and may not be divulged to anyone except the person who owns the information, those faculty, staff, or administrators who have need to know and those individuals or agencies who fulfill the requirements under the Federal Educational Rights and Privacy Act of 1974 at http://www.ed.gov/policy/gen/guid/fpco/ferpa/index.html , as amended (FERPA) and the Health Insurance Portability and Accountability Act (HIPAA) at http://www.cms.gov/Regulations-and-Guidance/HIPAA-Administrative-Simplification/HIPAAGenInfo/Downloads/HIPAALaw.pdf . If I release confidential information or discuss confidential information outside of the office, I understand that I will be immediately discharged from the Athletic Training Program.
I have read the above statement and agree to maintain the confidentiality of all information that I have access to through this office.

Athletic Training Student Signature		Date
Witness Signature		Date

EMERGENCY PROCEDURES

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